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Anthony Principi
Anthony Principi
As a nation, we have a sacred obligation to support the men and women who risk their lives to defend our freedom. That responsibility doesn’t end when their tour of duty ends. When our service members return home, we must ensure they have the medical care they need to live their best lives, and that includes treating mental illness.
Bipartisan majorities in Congress have made this issue a priority, most notably with overwhelming support for the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019.
Unfortunately, one provision in the Inflation Control Act of 2022 threatens to undermine this progress. The law unintentionally hampers the development of the next generation of psychiatric medications that could benefit countless veterans. The good news is that a simple, bipartisan solution is currently in the works.
Mental health issues are heartbreakingly common among our nation’s heroes. Rates of PTSD are higher among veterans than civilians. Sadly, an estimated 17 veterans commit suicide every day, and more than half of veterans with mental illnesses go untreated.
These heartbreaking statistics reflect the unique stresses and traumas of military life: exposure to combat, separation from family, and the transition back to civilian life can each take a huge psychological toll.
Pharmaceutical researchers have responded by expanding treatment options for mental illnesses: Currently, roughly half of all new drugs developed in the world are developed in the United States.
But affordability is also a major issue. To address that issue, the IRA gave Medicare the authority to negotiate lower prices with drug companies. Lawmakers wisely gave newly approved drugs a holiday from which to negotiate prices, so that drug companies had time to recoup their investment costs.
Curiously, however, this exemption period is not the same for all drug classes. “Large molecules” Biological drugs are exempt from government price negotiations for 13 years after FDA approval, but small molecule drugs are exempt for only nine years.
Not surprisingly, this disparity is already causing pharmaceutical companies to deprioritize or abandon small molecule therapeutics: In a recent survey of more than 20 large biopharmaceutical companies, 63% said they plan to shift their investments to small molecules due to IRAs.
This worrying trend could have serious consequences for veterans seeking treatment options for their mental illness. When it comes to treating mental illness, small molecules have a key advantage: they are small enough to cross the blood-brain barrier. As such, almost all psychiatric medications, from antipsychotics to antidepressants, are comprised of small molecules.
The IRA’s bias against small molecules also exacerbates existing inequalities in access to healthcare: Small molecule drugs typically come in the form of an easy-to-use pill, while biologics typically require injection or infusion by a medical professional.
Thankfully, a simple bipartisan solution is already in the works: the Ensuring Pathways to Innovative Therapies (EPIC) Act would align timelines for price negotiations between small molecules and biologics, providing each category with protections for 13 years after approval.
With millions of veterans suffering from mental and behavioral illnesses, we need to protect their access to transformative treatments, and that starts with passing the EPIC Act.
Anthony Principi served as Secretary of Veterans Affairs from 2001 to 2005. This column first appeared in Stars and Stripes.
